| NPI | 1093389322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL L LEE Pha/CEO 815-626-2230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2022-02-15 |